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General NPI Number Information
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NPI Number | 1649582255
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Entity Type | Individual
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Provider Name | CHRISTINE TERESA LOPEZ-PERGOLESE CASAC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 21 OLD ROUTE 6
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City | CARMEL
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State | NY
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Zip | 10512-2107
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Country | US
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Telephone | 914-257-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MARLBORO RD
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City | NEW FAIRFIELD
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State | CT
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Zip | 06812-3810
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Country | US
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Telephone | 34-822-4252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9568
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License Number State | NY
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